BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum leve...BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.展开更多
AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenat...AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.展开更多
文摘BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.
文摘AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.
